Browsing by Subject "Transcatheter aortic valve implantation"

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    Perceval Less Invasive Aortic Replacement Register: multicentric Spanish experience with the Perceval S bioprosthesis in moderate–high-risk aortic surgery
    (Oxford University Press, 2018-04-01) Berastegui García, Elisabet; Cámara Rosell, María Luisa; Estevez Cid, Francisco; Sánchez Domínguez, Eladio; Rios Barrera, Remedios; Sbraga, Fabrizio; García Puente, Julio; Rosello Díaz, Elena; Cuerpo Caballero, Gregorio Pablo; Bustamante Munguira, Juan; Reyes Copa, Guillermo; Tena Pajuelo, Marian; Serrano Fiz, Santiago; Buendía Miñano, José Alfonso; García Martín, Iván; Cuenca Castillo, Jose; Cánovas López, Sergio; González Pinto, Angel; Ruyra Baliarda, Xavier; Cirugía, Pediatría y Obstetricia y Ginecología
    OBJECTIVES The development of new percutaneous and surgical techniques has reduced the risk associated with aortic valve replacement procedures. We present the results of a Spanish register after initiating a programme for sutureless prostheses in moderate–high-risk patients. METHODS This prospective multicentre study was carried out from November 2013 to November 2016. Data were obtained from 448 patients in whom a Perceval S prosthesis was implanted. RESULTS The mean age was 79.24 (standard deviation [SD] 4.1) years, and 61.2% were women. The estimated EuroSCORE I log risk was 11.15% (SD 7.6), with an observed mortality of 4.4% (20 patients). Isolated aortic valve replacement was performed on 69.26% of patients, with 64% involving ministernotomy. The incidence of neurological events was 2%, with 2 permanent cerebrovascular accidents, and 41 (9.2%) patients were implanted with a permanent endocavitary pacemaker. At discharge, 12 (2.6%) patients presented minimal periprosthetic leakage, and 4 (0.89%) patients had moderate leakage. There were 3 reinterventions during follow-up (2 endocarditis and 1 dysfunction due to periprosthetic leak progression). The mean gradient at discharge, 6 months and 1 year was 12.94 (SD 5.3) mmHg, 12.19 (SD 4.7) mmHg and 11.77 (SD 4.7) mmHg, respectively; 59.4% of the patients were octogenarians, with a survival rate of 98% at both 6 months and 1 year at discharge. There was neither valve migration nor early structural degeneration. The mean follow-up was 12 ± 3 months. The 6-month and 1-year mortality was 1.4% and 2.1%, respectively. CONCLUSIONS This is a prospective multicentric study on the largest cohort of patients with sutureless valves conducted in Spain to date. It is a reproducible procedure that has enabled surgery on patients with a moderate–high risk with low morbidity and mortality, providing good haemodynamic results.
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    Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry
    (Elsevier, 2013-10-22) Ribeiro, Henrique B.; Webb, John G.; Makkar, Raj R.; Cohen, Mauricio G.; Kapadia, Samir R.; Kodali, Susheel; Tamburino, Corrado; Barbanti, Marco; Chakravarty, Tarun; Jilaihawu, Hasan; Paradis, Jean-Michel; Brito, Fabio S. de; Cánovas López, Sergio; Cheema, Asim N.; Jaegere, Peter P. de; Valle, Raquel del; Chiam, Paul T. L.; Moreno, Raúl; Pradas, Gonzalo; Ruel, Marc; Salgado Fernández, Jorge; Sarmento-Leite, Rogerio; Toeg, Hadi D.; Velianou, James L.; Zajarias, Alan; Babaliaros, Vasilis; Cura, Fernando; Dager, Antonio E.; Manoharan, Ganesh; Lerakis, Stamatios; Pichard, Augusto D.; Radhakrishnan, Sam; Perin, Marco Antonio; Dumont, Eric; Larose, Eric; Pasian, Sergio G.; Nombela-Franco, Luis; Urena, Marina; Murat Tuzcu, E.; Leon, Martin B.; Amat-Santos, Ignacio J.; Leipsic, Jonathon; Rodés Cabau, Josep; Cirugía, Pediatría y Obstetricia y Ginecología
    Objectives: This study sought to evaluate the main baseline and procedural characteristics, management, and clinical outcomes of patients from a large cohort of patients undergoing transcatheter aortic valve implantation (TAVI) who suffered coronary obstruction (CO). Background: Very little data exist on CO following TAVI. Methods: This multicenter registry included 44 patients who suffered symptomatic CO following TAVI of 6,688 patients (0.66%). Pre-TAVI computed tomography data was available in 28 CO patients and in a control group of 345 patients (comparisons were performed including all patients and a cohort matched 1:1 by age, sex, previous coronary artery bypass graft, transcatheter valve type, and size). Results: Baseline and procedural variables associated with CO were older age (p < 0.001), female sex (p < 0.001), no previous coronary artery bypass graft (p = 0.043), the use of a balloon-expandable valve (p = 0.023), and previous surgical aortic bioprosthesis (p = 0.045). The left coronary artery was the most commonly involved (88.6%). The mean left coronary artery ostia height and sinus of Valsalva diameters were lower in patients with obstruction than in control subjects (10.6 ± 2.1 mm vs. 13.4 ± 2.1 mm, p < 0.001; 28.1 ± 3.8 mm vs. 31.9 ± 4.1 mm, p < 0.001). Differences between groups remained significant after the case-matched analysis (p < 0.001 for coronary height; p = 0.01 for sinus of Valsalva diameter). Most patients presented with persistent severe hypotension (68.2%) and electrocardiographic changes (56.8%). Percutaneous coronary intervention was attempted in 75% of the cases and was successful in 81.8%. Thirty-day mortality was 40.9%. After a median follow-up of 12 (2 to 18) months, the cumulative mortality rate was 45.5%, and there were no cases of stent thrombosis or reintervention. Conclusions: Symptomatic CO following TAVI was a rare but life-threatening complication that occurred more frequently in women, in patients receiving a balloon-expandable valve, and in those with a previous surgical bioprosthesis. Lower-lying coronary ostium and shallow sinus of Valsalva were associated anatomic factors, and despite successful treatment, acute and late mortality remained very high, highlighting the importance of anticipating and preventing the occurrence of this complication.